Lucentis

ranibizumab

(ran-i-bi-zoo-mab) ,

Lucentis

(trade name)

Classification

Therapeutic: ocular agents
Pharmacologic: monoclonal antibodies
Pregnancy Category: C

Indications

Neovascular (wet) age-related macular degeneration.Macular edema following retinal vein occlusion.Diabetic macular edema

Action

Binds to vascular endothelial growth factor A (VEGF-A) receptor sites, preventing the binding of endogenous VEGF-A, resulting in decreased endothelial proliferation, vascular leakage and new vessel formation.

Therapeutic effects

Decreased progression of visual loss.

Pharmacokinetics

Absorption: Intravitreal injection results in complete local bioavailability. Very low serum levels are achieved.
Distribution: Unknown.
Metabolism and Excretion: Unknown.
Half-life: 9 days (intravitreal).

Time/action profile

ROUTEONSETPEAKDURATION
intravitrealunknownafter injection1 mo

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Ocular/periocular infections.
Use Cautiously in: Obstetric: Use only in pregnancy if clearly needed, use cautiously during lactation; Pediatric: Safety not established.

Adverse Reactions/Side Effects

Ear, Eye, Nose, Throat

  • conjunctival hemorrhage (most frequent)
  • eye pain (most frequent)
  • ↑ intraocular pressure (most frequent)
  • intraocular inflammation (most frequent)
  • vitreal floaters (most frequent)
  • endophthalmitis
  • retinal detachment

Cardiovascular

  • arterial thromboembolic events (life-threatening)

Interactions

Drug-Drug interaction

↑ risk of serious intraocular inflammation with verteporfin.

Route/Dosage

Macular Degeneration

Intravitreal (Adults) 0.5 mg (0.05 mL) once monthly; after 4 mo, injections may be given every 1–3 mo.

Macular Edema Following Retinal Vein Occlusion

Intravitreal (Adults) 0.5 mg (0.05 mL) once monthly.

Diabetic Macular Edema

Intravitreal (Adults) 0.3 mg (0.05 mL) once monthly.

Availability

Solution for intravitreal injection: 0.3 mg (0.05 mL)/vial, 0.5 mg (0.05 mL)/vial

Nursing implications

Nursing assessment

  • Assess eye for signs of infection frequently during week following injection.
  • Check perfusion of optic nerve head immediately after injection, use tonometry to measure intraocular pressure prior to and 60 min following the injection.

Potential Nursing Diagnoses

Disturbed sensory perception (Indications)

Implementation

  • Do not administer solutions that are discolored or contain particulate matter. Attach threaded plastic threader rod to the rubber stopper inside barrel of syringe. Do not pull back on plunger.
    • Adequate analgesia and a broad-spectrum antibiotic should be given prior to injection.
  • Intravitreal: For ophthalmic intravitreal injection only. Withdraw vial contents through a 5–micron gauge filter needle attached to a 1–cc tuberculin syringe. Discard filter needle after withdrawal. Replace filter needle with sterile 30–gauge x 1/2-inch needle for intravitreal injection. Expel contents until plunger tip is aligned with line marking 0.05 mL on syringe Each vial should be used for only one eye. If contralateral eye requires treatment, use new vial and equipment. Refrigerate solution and protect from light; do not freeze.

Patient/Family Teaching

  • Advise patient to notify ophthalmologist immediately if eye becomes red, sensitive to light, painful, or develops a change in vision.

Evaluation/Desired Outcomes

  • Slowing of vision loss.

Lucentis

a trademark for ranibizumab.
Mentioned in ?
References in periodicals archive ?
Her local primary care trust has refused to pay for the drug Lucentis (ranibizumab), which could stabilise her condition or improve it.
Now that it will be available, Lucentis therapy can begin to make a difference in the lives of our patients with DME.
Eylea appears to be competing directly for patient share with the standard of care, Novartis's Lucentis, although Lucentis remains the market leader across the EU5 markets and continues to be viewed by the majority of retinal specialists to be their typical first-line treatment approach for wet AMD.
Novartis has announced the launch of the Lucentis (ranibizumab) pre-filled syringe (PFS) in Germany, with other markets to follow throughout 2014.
THE SCOTTISH Medicines Consortium (SMC) has accepted Lucentis (ranibizumab) for use within the NHS as a treatment option for people with visual impairment due to macular oedema secondary to branch retinal vein occlusion (BRVO).
Cancer treatments Avastin and Herceptin and macular degeneration treatment Lucentis are sold by Genentech Inc.
They won a fight to get Warwickshire Primary Care Trust (PCT) to prescribe them Lucentis following a High Court action.
The Royal National Institute for the Blind (RNIB) is urging the South Staffordshire PCT to give more people with wet-Age Related Macular Degeneration, a condition that could lead to blindness in a matter of months, access to the Lucentis drug.
But in a second set of draft recommendations yesterday, Nice proposed that the drug Lucentis should be made available to treat the majority of patients with wet AMD.
It reported that the Welsh Assembly Finance Committee was concerned about the costs of new treatments to the NHS, and specifically mentioned one of the new sight-saving treatments called Lucentis.
A meeting schedule for today on the guidance, which relates to the drugs Lucentis (ranibizumab) and Macugen (pegaptanib), has been postponed.
Health chiefs in the North East have agreed to pay for Lucentis, a treatment for aged-related macular degeneration, from Wednesday.